The laparoscope (peritoneoscope, celioscope) is an important tool of modern gynecologic diagnosis and surgical treatment. A prior art technique of laparoscopy requires the intoductidn of a needle into the peritoneal cavity to establish a pneumoperitoneum, and the abdominal wall is then punctured with a cannula, bearing a sharp trochar. Both of these steps are performed blindly, and there is thus the possibility of accidentally puncturing a vital organ or a blood vessel. The trochar is subsequently withdrawn, and the lighted laparoscope is inserted through the cannula into the peritoneal cavity for visualization.
Another technique of performing laparoscopy is discussed in my article in the American Journal of Obstetrics and Gynecology, St. Louis, Vol. 110, No. 6, pages 886-887, July 15, 1971. In this technique, a laparoscope cannula with a trumpet valve is fitted with a thin, cone-shaped steel sleeve, mounted on the cannula's shaft. The cone sleeve may be fitted with an extender to accommodate variations in the thickness of the abdominal wall and in the distance between the umbilicus and the symphysis pubis.
The purpose of the conical sleeve is to seal the peritoneal and fascial gap, by advancing the cone deeper through the incisional opening. Although the use of such a cannula has been found generally satisfactory, certain problems were noted. These problems included the occasional occurrence of gas leaks, the need for an assistant to hold the cannula in place while the scope was being withdrawn or manipulated, and the need to use several cannulas of different sizes to accommodate individual variations in the thickness of the abdominal wall.
In my U.S. Pat. No. 3,817,251, issued June 18, 1974, I disclosed a laparoscope cannula which alleviated the aforementioned problems by utilizing a generally truncated cone-shaped sleeve which is adjustably positioned on the distal shaft portion and by utilizing hooks carried by the cannula for receiving a suture, to maintain the cannula in place with respect to the patient's abdomen.
It has been found, however, that the hooks are difficult for some persons to utilize because on occasion the suture may loosen if the suture is not tied properly. Further, the degree of tension is unpredictable, thereby leading to possible escape of the gas because the sleeve may not be in a snug position within the fascia. Further, with the use of hooks, it is necessary to tie a knot with the suture and the tying of the knot may result in the breaking of the suture if excessive tension is applied. Still further, the tying of the knot may take some persons a relatively long time and thus become inefficient in actual practice.
The present invention is an improvement upon the laparoscope cannula disclosed in my U.S. Pat. No. 3,817,251, in that it provides novel suture-receiving means that significantly alleviate the problems concomitant with the use of hooks.